Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study
Abstract Background Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson’s disease (PwPD), its effect on motor axial symptoms (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait) is still...
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2025-04-01
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| Series: | Journal of NeuroEngineering and Rehabilitation |
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| Online Access: | https://doi.org/10.1186/s12984-025-01616-w |
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| author | Matteo Guidetti Sara Marceglia Tommaso Bocci Ryan Duncan Alfonso Fasano Kelly D. Foote Clement Hamani Joachim K. Krauss Andrea A. Kühn Francesco Lena Patricia Limousin Andres M. Lozano Natale V. Maiorana Nicola Modugno Elena Moro Michael S. Okun Serena Oliveri Marco Santilli Alfons Schnitzler Yasin Temel Lars Timmermann Veerle Visser-Vandewalle Jens Volkmann Alberto Priori |
| author_facet | Matteo Guidetti Sara Marceglia Tommaso Bocci Ryan Duncan Alfonso Fasano Kelly D. Foote Clement Hamani Joachim K. Krauss Andrea A. Kühn Francesco Lena Patricia Limousin Andres M. Lozano Natale V. Maiorana Nicola Modugno Elena Moro Michael S. Okun Serena Oliveri Marco Santilli Alfons Schnitzler Yasin Temel Lars Timmermann Veerle Visser-Vandewalle Jens Volkmann Alberto Priori |
| author_sort | Matteo Guidetti |
| collection | DOAJ |
| description | Abstract Background Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson’s disease (PwPD), its effect on motor axial symptoms (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait) is still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. freezing of gait) in the general population with PD. Despite the positive potential of combined PT and STN-DBS surgery, scientific results are still lacking. We therefore involved worldwide leading experts on DBS and motor rehabilitation in PwPD in a consensus Delphi panel to define the current level of PT recommendation following STN-DBS surgery. Methods After summarizing the few available findings through a systematic scoping review, we identified clinically and academically experienced DBS clinicians (n = 21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review, thirty-nine questions were designed and submitted to the panel–half related to general considerations on PT following STN-DBS, and half related to PT treatments. Results Despite the low-to-moderate quality of data, the few available rehabilitation studies suggested that PT could improve dynamic and static balance, gait performance and posture in the population with PD receiving STN-DBS. Similarly, the panellists strongly agreed that PT might help improve motor symptoms and quality of life, and it may be prescribed to maximize the effects of stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed that conventional PT, but not massage or manual therapy, should be prescribed because of the specificity of STN-DBS implantation. Conclusions Although RCT evidence is lacking, upon Delphi panel, PT for PwPD receiving STN-DBS can be potentially useful to maximize clinical improvement. However, more research is needed, with RCTs and well-designed studies. The rehabilitation and DBS community should expand this area of research to create guidelines for PT following STN-DBS. Graphical abstract |
| format | Article |
| id | doaj-art-c38dedaac2b54ec9b1f837c3dc5ba1c1 |
| institution | OA Journals |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj-art-c38dedaac2b54ec9b1f837c3dc5ba1c12025-08-20T02:16:06ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032025-04-0122112110.1186/s12984-025-01616-wIs physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus studyMatteo Guidetti0Sara Marceglia1Tommaso Bocci2Ryan Duncan3Alfonso Fasano4Kelly D. Foote5Clement Hamani6Joachim K. Krauss7Andrea A. Kühn8Francesco Lena9Patricia Limousin10Andres M. Lozano11Natale V. Maiorana12Nicola Modugno13Elena Moro14Michael S. Okun15Serena Oliveri16Marco Santilli17Alfons Schnitzler18Yasin Temel19Lars Timmermann20Veerle Visser-Vandewalle21Jens Volkmann22Alberto Priori23Aldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanAldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanAldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanSchool of Medicine, Program in Physical Therapy, Washington University in St. LouisKrembil Research Institute, University Health NetworkDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of FloridaSunnybrook Health Sciences CentreDepartment of Neurosurgery, Hannover Medical SchoolDepartment of Neurosurgery, Hannover Medical SchoolDepartment of Medicine and Health, University of MoliseDepartment of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryKrembil Research Institute, University Health NetworkAldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanIRCCS INM NeuromedDivision of Neurology, CHU of Grenoble, Grenoble Institute of Neurosciences, INSERM U1216, Grenoble Alpes UniversityDepartment of Neurology, Norman Fixel Institute for Neurological Diseases, University of FloridaAldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanIRCCS INM NeuromedInstitute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine UniversityDepartment of Neurosurgery, Maastricht University Medical CenterDepartment of Neurology, University Hospital of MarburgDepartment of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of CologneDepartment of Neurology, University Hospital WürzburgAldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of MilanAbstract Background Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson’s disease (PwPD), its effect on motor axial symptoms (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait) is still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. freezing of gait) in the general population with PD. Despite the positive potential of combined PT and STN-DBS surgery, scientific results are still lacking. We therefore involved worldwide leading experts on DBS and motor rehabilitation in PwPD in a consensus Delphi panel to define the current level of PT recommendation following STN-DBS surgery. Methods After summarizing the few available findings through a systematic scoping review, we identified clinically and academically experienced DBS clinicians (n = 21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review, thirty-nine questions were designed and submitted to the panel–half related to general considerations on PT following STN-DBS, and half related to PT treatments. Results Despite the low-to-moderate quality of data, the few available rehabilitation studies suggested that PT could improve dynamic and static balance, gait performance and posture in the population with PD receiving STN-DBS. Similarly, the panellists strongly agreed that PT might help improve motor symptoms and quality of life, and it may be prescribed to maximize the effects of stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed that conventional PT, but not massage or manual therapy, should be prescribed because of the specificity of STN-DBS implantation. Conclusions Although RCT evidence is lacking, upon Delphi panel, PT for PwPD receiving STN-DBS can be potentially useful to maximize clinical improvement. However, more research is needed, with RCTs and well-designed studies. The rehabilitation and DBS community should expand this area of research to create guidelines for PT following STN-DBS. Graphical abstracthttps://doi.org/10.1186/s12984-025-01616-wDeep brain stimulationDBSPhysiotherapyMotor rehabilitationPhysical therapyDelphi consensus |
| spellingShingle | Matteo Guidetti Sara Marceglia Tommaso Bocci Ryan Duncan Alfonso Fasano Kelly D. Foote Clement Hamani Joachim K. Krauss Andrea A. Kühn Francesco Lena Patricia Limousin Andres M. Lozano Natale V. Maiorana Nicola Modugno Elena Moro Michael S. Okun Serena Oliveri Marco Santilli Alfons Schnitzler Yasin Temel Lars Timmermann Veerle Visser-Vandewalle Jens Volkmann Alberto Priori Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study Journal of NeuroEngineering and Rehabilitation Deep brain stimulation DBS Physiotherapy Motor rehabilitation Physical therapy Delphi consensus |
| title | Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study |
| title_full | Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study |
| title_fullStr | Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study |
| title_full_unstemmed | Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study |
| title_short | Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study |
| title_sort | is physical therapy recommended for people with parkinson s disease treated with subthalamic deep brain stimulation a delphi consensus study |
| topic | Deep brain stimulation DBS Physiotherapy Motor rehabilitation Physical therapy Delphi consensus |
| url | https://doi.org/10.1186/s12984-025-01616-w |
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